Beyond the EHR: Complementing clinical records with usable data

The healthcare industry is inundated with patient records and platforms on which to store those records. There are EHRs and there are personal health records and even patient portals, but the information these platforms store and display only make up a sliver of an individual's health information.

In the shifting healthcare environment, healthcare providers are focusing more on how to keep people healthy and out of the hospital, yet with the current platform offerings of EHRs and PHRs, individuals don't have the necessary tools to take control of their health, argues Jeff Margolis, chairman and CEO of Welltok.

EHRs are, of course, the clinical record of a patient's experience in a healthcare facility. PHRs don't necessarily have a standard definition other than the fact they are accessible by a patient instead of a clinician. Mr. Margolis writes in his book "The Healthcare Cure: How Sharing Information Can Make the System Work Better" that a PHR ideally contains historical information about all the treatments a patient receives from all providers. PHRs are ideally populated by payers, because they receive information about every episode of care an individual receives.

"In a PHR, you can see a more longitudinal view of everything in your history across all settings because each of those settings had to submit a claim or an encounter for payment to the health plan," Mr. Margolis tells Becker's Hospital Review.

However, the issue with EHRs and PHRs is that they only give you clinical information about what happened inside the walls of healthcare facility, according to Mr. Margolis, despite the fact that individuals more often than not spend most of their time outside of the hospital.

"If all you're doing is extracting the clinical history of somebody into a PHR, that's not a bad thing, but a PHR does not key up for a consumer a list or itinerary that's personalized to them about the things they can do to proactively maintain the highest health status at the lowest cost," Mr. Margolis says.

What the industry is missing, he says, is a consumer-facing platform displaying a holistic image of the whole person's well-being. Welltok's version of this is CaféWell, a "health optimization platform" that provides personalized information to individuals to help them maintain and/or achieve wellness.

Currently, clinicians generally control the information entered into a PHR, and the information is reactive to the episode of care. This type of data does not provide actionable information that an individual can use every day, Mr. Margolis says.

"The whole world tries to start from the doctor up, but how much time do you spend in a clinical setting?" Mr. Margolis asks. "While it might be interesting to look at what happened to you for that tenth of a percentage of a time, you need something to guide you 99.99 percent of the time."

CaféWell provides personalized information for individuals to meet their health needs, whether it be medication management, social support for conditions or general fitness. Mr. Margolis calls it a "personal health itinerary."

Platforms like Welltok's CaféWell aren't intended to replace EHRs and PHRs; rather, they're complementary to them. Clinical encounters will happen, but the information individuals need to make healthy decisions is required everyday.

"You don't have to recreate patient portals and PHRs. You just need to provide access to those when they're necessary," Mr. Margolis says.

Population health is taking the healthcare industry by storm. Hospitals are developing programs geared at analyzing the health of their populations and implementing initiatives to boost overall wellness. While the responsibility for healthy living largely lies in the hands of the consumers, they need the adequate tools to coach them and get them to where they need to go.

"[To improve] quality and affordability of healthcare, you have to get well beyond what EMRs, EHRs and PHRs can do to get there," Mr. Margolis says.

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